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Treatment for Acute otitis Media if Penicillin allergy?

Answer generated on June 4, 2024

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For patients with acute otitis media who have a penicillin allergy, recommended treatments include cefdinir, cefuroxime, cefpodoxime, or ceftriaxone.^[1-2]

Cefdinir can be administered orally with dosages varying by age; for instance, children 6 years and older may receive 7 mg/kg/dose every 12 hours or 14 mg/kg/dose every 24 hours for 5 to 7 days for mild to moderate disease, and 10 days for severe disease.^[3]
Cefuroxime is another option, with dosages such as 15 mg/kg/dose orally every 12 hours for 10 days for infants and children 3 to 23 months.^[2]
Cefpodoxime can be given at 5 mg/kg/dose orally every 12 hours for 5 to 7 days for mild to moderate disease, and for 10 days for severe disease in children 6 years and older.^[4]
Ceftriaxone, suitable for more severe cases or failures with initial therapy, can be administered as a 3-day course.^[2]

Additional info

When selecting an antibiotic for a patient with a penicillin allergy, it's crucial to consider the severity of the allergy. Cephalosporins, such as cefdinir, cefuroxime, and cefpodoxime, generally have low cross-reactivity rates with penicillins, making them a safer choice for patients with non-severe penicillin allergies. However, for patients with a history of severe penicillin allergy, consultation with an allergist for skin testing might be advisable before using cephalosporins. Macrolides like azithromycin and clarithromycin are alternatives but have limited efficacy against common pathogens causing acute otitis media, such as Haemophilus influenzae and many Streptococcus pneumoniae.^[5] Therefore, they are generally not preferred unless other options are contraindicated or not tolerated.

References

Reference 1

Elsevier ClinicalKey Drug Class Overview

Content last updated: January 1, 2012.

Amoxicillin or amoxicillin; clavulanate are the drugs of choice for treatment of otitis media; treat clinical failures to amoxicillin; clavulanate with parenteral ceftriaxone. In patients with a penicillin allergy, cefdinir, cefpodoxime, or ceftriaxone are suggested[54667].

Reference 2

Elsevier ClinicalKey Clinical Overview

Treatment Patient has concurrent purulent conjunctivitis Patient has history of recurrent acute otitis media unresponsive to amoxicillin Patient for whom amoxicillin has failed at 48 to 72 hours Some experts suggest amoxicillin-clavulanate could be the preferred treatment for all children owing to the increase in cases caused by Haemophilus influenzae and decrease in prevalence of penicillin-resistant Streptococcus pneumoniae However, treatment failure and recurrence remain uncommon, and rates are lower for amoxicillin than for other agents despite changes in acute otitis media etiology Patients with penicillin allergy Cephalosporin cross-reaction rates are low (0.1%) among patients with a history of mild to moderate penicillin allergy (not severe reactions) The following antibiotics are recommended as first line therapy for patients without severe and/or recent penicillin allergy when skin testing is not available: Cefdinir Cefuroxime Cefpodoxime Ceftriaxone If patient's condition fails to improve or respond to initial therapy after 48 to 72 hours, change initial antibiotic to either of the following Amoxicillin-clavulanate combination Ceftriaxone (3-day course) Alternative second line therapies after 48 to 72 hours of initial antibiotic treatment Cefpodoxime or cefdinir (third-generation cephalosporins) plus clindamycin Ceftriaxone (3-day course) plus clindamycin Second- or third-generation cephalosporin treatment alone is also recommended by some experts When treatment persistently fails, consult otolaryngology subspecialist for further antibiotic therapy recommendations, follow-up, and possible tympanocentesis Macrolides have limited efficacy against Haemophilus influenzae and many Streptococcus pneumoniae middle ear isolates

Treatment Amoxicillin Trihydrate, Clavulanate Potassium Oral suspension; Children 6 to 12 years: 90 mg/kg/day amoxicillin component (Max: 4,000 mg amoxicillin/day) PO divided every 12 hours for 5 to 7 days for mild to moderate disease and 10 days for severe disease. If child has a penicillin allergy, alternative first line oral therapies include: Cefdinir Cefdinir Oral suspension; Infants 2 to 5 months†: 7 mg/kg/dose PO every 12 hours or 14 mg/kg/dose PO every 24 hours for 10 days. Cefdinir Oral suspension; Infants and Children 6 to 23 months: 7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours or 14 mg/kg/dose (Max: 600 mg/dose) PO every 24 hours for 10 days. Cefdinir Oral suspension; Children 2 to 5 years: 7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours or 14 mg/kg/dose (Max: 600 mg/dose) PO every 24 hours for 7 days for mild to moderate disease and 10 days for severe disease. Cefdinir Oral suspension; Children 6 years and older: 7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours or 14 mg/kg/dose (Max: 600 mg/dose) PO every 24 hours for 5 to 7 days for mild to moderate disease and 10 days for severe disease. Cefuroxime Cefuroxime Axetil Oral suspension; Infants and Children 3 to 23 months: 15 mg/kg/dose PO every 12 hours for 10 days. Cefuroxime Axetil Oral suspension; Children 2 to 5 years: 15 mg/kg/dose PO every 12 hours for 7 days for mild to moderate disease and 10 days for severe disease.

Reference 3

Elsevier ClinicalKey Drug Monograph

Content last updated: January 3, 2024.

Indications And Dosage **For the treatment of acute otitis media** Oral dosage Children 6 years and older: 7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours or 14 mg/kg/dose (Max: 600 mg/dose) PO every 24 hours for 5 to 7 days for mild to moderate disease and 10 days for severe disease. Guidelines recommend cefdinir as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients. Children 2 to 5 years: 7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours or 14 mg/kg/dose (Max: 600 mg/dose) PO every 24 hours for 7 days for mild to moderate disease and 10 days for severe disease. Guidelines recommend cefdinir as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients. Infants and Children 6 to 23 months: 7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours or 14 mg/kg/dose (Max: 600 mg/dose) PO every 24 hours for 10 days. Guidelines recommend cefdinir as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients. Infants 2 to 5 months†: 7 mg/kg/dose PO every 12 hours or 14 mg/kg/dose PO every 24 hours for 10 days. Guidelines recommend cefdinir as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.

Reference 4

Elsevier ClinicalKey Drug Monograph

Content last updated: April 1, 2024.

Indications And Dosage **For the treatment of acute otitis media** Oral dosage (suspension) Children 6 years and older: 5 mg/kg/dose (Max: 200 mg/dose) PO every 12 hours for 5 to 7 days for mild to moderate disease and for 10 days for severe disease. Guidelines recommend vantin as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients. Children 2 to 5 years: 5 mg/kg/dose PO every 12 hours for 7 days for mild to moderate disease and for 10 days for severe disease. Guidelines recommend vantin as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients. Infants and Children 2 to 23 months: 5 mg/kg/dose PO every 12 hours for 10 days. Guidelines recommend vantin as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.

Reference 5